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Part A: Personal Details






MaleFemale










NoYes




Part B: Parent/Guardian Details

(The following information is required to enable the college to contact parent/guardian on student’s learning progress and in the event of emergency)


Dato'DatinDrMrMrsMdmMs








Part C: Family Details

(The following information is required by the Ministry of Higher Education Malaysia as stipulated under Section 33(c) of the Akta Institut Pengajian Tinggi Swasta 1996)

of the abovenamed in Part B *


FatherMotherSiblingRelativeGuardianOthers

of the abovenamed in Part B *


MalaysianOthers


below RM3000/monthRM3001-RM5000/monthRM5001-RM7000/monthRM7001-RM10000/monthAbove RM10001/month


Part D: Academic Records


SMSMKSMJKPRIVATEINTERNATIONALOTHERS



SPMSTPMO-LEVELA-LEVELSACEUECOTHERS


SPMIELTSTOEFLOTHERS

(if applicable)



(for Pre-U Studies only : SACE / A-LEVEL)


Part E: File Upload

(for International applicant, please upload the Passport Identity Information Page)
Supported file types: jpeg


(for International applicant, please upload the Passport Identity Information Page)
Supported file types: jpeg




* Indicates required fields.

Note:
- Attachment size limit: 2MB.
-- Supported file types: doc, docx, pdf, txt, jpg, jpeg, png


I have read the Personal Data Protection and Privacy Policy (https://www.disted.edu.my/privacy-policy) and agreeable to DISTED to process my personal data accordingly.

I consent to the processing by DISTED, personal data (including sensitive personal data as stated in the Data Protection Act 2010) about me for the purposes related to publicity and/or promotional events, including using of photographs/images or recordings, the publishing of examination results, the award of a prize or scholarship and any other achievement, academic or otherwise.